We are members of the Chesterfield Girls Basketball League.
More information on CGBL can be found at www.thecgbl.com

2018 Basketball Registration Are Now Open

* Important: This online application will fill out all forms needed to register your child to play. Once the form is filled out and submitted, you will receive an email will all the forms needed in a Word Doc. Please print them out, sign them, and bring them to Registration along with the Fee’s.

Player's First Name:*

Player's Last Name:*

Date of Birth:*

MM

DD

YYYY

Age as of December 31st, 2018*

Street Address:*

City & State:*

Zip:*

Father's Name:*

Father's Phone:*

Mother's Name:*

Mother's Phone:*

Email:*

Home/Cell Phone:*

Elementary School Boundary:*

School Attended:

Grade:*

Level of Play*

Instructional (7-8)*

Minor (9-10)

Intermediate (11-12)

Junior (13-14)

Senior (15-18)**

*Instructional focuses on teaching young players fundamental skills of the game. Practices/scrimmages will be held Saturday morning beginning in January.

** Seniors must be enrolled in high school

There will be a $20.00 returned check charge on any check deposited in the account of CHSA and returned for any reason.

I/We the parent(s)/guardian(s) of the above named child hereby give my/our approval for her participation in any and all CLOVER HILL SPORTS ASSOCIATION sponsored activities for the sport of BASKETBALL. I/We assume all risks and hazards incidental to such participation including transportation to and from the activities, and I/we do hereby waive, release, absolve, indemnify, and agree to hold harmless, the CLOVER HILL SPORTS ASSOCIATION, the organizers, Sponsors, Coaches, Participants, and Persons transporting my/our daughter, except to the extent and in the amount covered by accident or liability insurance. I/we agree to furnish a certified birth certificate or certified legal proof of birth or other legal proof as may be requested by the Association or League for the above named participant. I/we agree to be responsible for any registration fees due prior to the season. I/we, the parent(s)/guardian(s) of the above named child, who is a member of CLOVER HILL SPORTS ASSOCIATION, do hereby acknowledge that my/our child is in good physical condition and to the best of my/our knowledge is without such ailments that could create and/or cause problems due to strenuous activity (for example: asthma, migraine headaches, weak back/joints, prone to fainting or dizziness, diabetes, heart conditions, extreme allergic reactions, or other physical or chronic disorders). If any, please explain as it is to everyone’s advantage that we are aware in the event of an emergency and does not necessarily mean that the child will be unable to participate in the sport. As a parent/guardian of the above named child, I do further give my express permission for the son/daughter to be treated for any illness or injury sustained in connection with her duties as a member of CLOVER HILL SPORTS ASSOCIATION, should such illness or injury occur during my absence.

Are there any medical conditions we should be aware of?

Upload Child's Birth Certificate

Our Site is Highly Secured, so don't worry about your information being lost in the cloud or stolen! Please note, that your child can not start practice until this is turned in. If you rather turn it in during in-person registration, please skip this.

By typing your name, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature in this Agreement.

Signature (E-Signature):*

Date:*

Please Choose One!

I'll Pay Now Online!

I'd Rather Pay In-Person.

PLEASE NOTE: We use PayPal to secure online payments. You do not need to have a PayPal account to pay for Registration, you can use the option to pay by Credit/Debit card without having or signing up for a PayPal account!!!

Instructional League - $125.00 + $5 Credit Card Processing Fee

Price:$130.00Quantity:

Minor - Seniors - $145.00 + $5 Credit Card Processing Fee

Price:$150.00Quantity:

Total

$0.00

Once the form is submitted, you are able to download the form. Also, the form will be sent to the email provided above. Please print this form and bring to in person registration signed. Also, if you are a FREE AGENT NOT REQUIRING RELEASE or a FREE AGENT REQUIRING RELEASE, please fill out the remaining information on this form.